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Pensar Enfermagem / v.28 n.01 / January 2024

DOI: 10.56732/pensarenf.v28i1.286

Review Article

How to cite this article: Tereso A, Curado A, Brantes A, Antunes R. Assessment instruments to evaluate

sexual function and satisfaction of pregnant women in prenatal health care context: scoping review protocol.

Pensar Enf [Internet]. 2024 Jan; 28(1): 6-13. Available from: https://doi.org/10.56732/pensarenf.v28i1.286

Assessment instruments to evaluate sexual function

and satisfaction of pregnant women in prenatal

health care context: scoping review protocol

Abstract

Introduction

Despite the fears and beliefs related to sexual function and satisfaction during pregnancy,

the healthy experience of sexuality (which is not reduced to these aspects but encompasses

them) is relevant to women. Although quality of life is associated with sexual function and

satisfaction, the effect of pregnancy in those dimensions, needs to be further explored in

order to prevent problems and respond appropriately to women needs.

Objective

This scoping review aims to map, in the scientific literature, the assessment instruments

to evaluate the sexual function and sexual satisfaction of pregnant women in prenatal

health care context.

Methods

The Joanna Briggs Institute guidelines are used to conduct this protocol. The key

information sources to be searched include several databases, such as MEDLINE,

CINAHL, MedicLatina, Pubmed, Web of Science, Google Scholar and Open Access

Scientific Repository of Portugal.

Quantitative, qualitative, or mixed studies and secondary studies published in Portuguese,

English, Spanish, French, and between 2018 and 2023 will be included. For inclusion

criteria will be considered studies referring to instruments to evaluate sexual function and

satisfaction of pregnant woman 18 years or over, in prenatal health care context [Population

Concept Context framework]. Titles and abstracts of identified citations will be screened

independently and assessed for eligibility by two reviewers. Potentially relevant full-text

studies and data will be extracted using a data extraction form. The extraction table will

show the data mapped in a descriptive way responding to research questions. Selected

documents by each reviewer will be uploaded to the Covidence web tool, to optimize the

systematic review process and facilitate collaboration between reviewers. For the

management of references, the Mendeley software will be used.

Discussion

Mapping the instruments will enable to summarize the valid, reliable, and specific

assessment instruments, their possibilities, and limitations. This results, will contribute to

improve the access to information about sexual function and satisfaction during pregnancy,

to identify women needs, and plan specific health care interventions. The outcomes

relevance will help to guide health professionals and researchers to use the most appropriate

assessment tools in prenatal health care context.

Systematic review registration

Open Science Framework - registration number: osf.io/csg8t

Keywords

Pregnant Woman; Sexual Satisfaction; Scales; Sexual Health.

Alexandra Tereso1

orcid.org/0000-0002-4746-3649

Alice Curado2

orcid.org/0000-0002-9942-7623

Ana Brantes3

orcid.org/0000-0002-2815-260X

Ricardo Antunes4

orcid.org/0000-0003-4771-3975

1 PhD. Nursing School of Lisbon (ESEL), Lisbon.

Nursing Research, Innovation and Development

Centre of Lisbon (CIDNUR), Lisbon, Portugal.

2 PhD. Nursing School of Lisbon (ESEL), Lisbon.

Nursing Research, Innovation and Development

Centre of Lisbon (CIDNUR), Lisbon, Portugal.

3 Master. Nursing School of Lisbon (ESEL), Lisbon.

Nursing Research, Innovation and Development

Centre of Lisbon (CIDNUR), Lisbon, Portugal.

4 PhD. Nursing School of Lisbon (ESEL), Lisbon.

Nursing Research, Innovation and Development

Centre of Lisbon (CIDNUR), Lisbon, Portugal.

Corresponding author:

Alexandra Tereso

E-mail: alexandra.tereso@essel.pt

Received: 05.07.2023

Accepted: 18.12.2023

Pensar Enfermagem / v.28 n.01 / January 2024 | 7

DOI: 10.56732/pensarenf.v28i1.286

Review Article

Introduction

Despite the fears, myths and misconceptions related to

sexual function and satisfaction during pregnancy, the

healthy experience of sexuality (which is not reduced to

these aspects but encompasses them) is relevant to the

pregnant women. Although quality of life is associated with

woman sexual function and satisfaction, the effect of

pregnancy in those dimensions, needs to be further

explored. According to the American College of

Obstetricians and Gynaecologists1, most sexual activity is

safe for women having healthy pregnancies and this includes

sexual intercourse or penetration with fingers or sex toys.

Nevertheless, the sexual needs of pregnant women are rarely

discussed with health professionals in prenatal care, and

sexual activity and pleasure during this period, seems to be

a taboo. 2 Pregnancy is a peculiar stage in terms of the

physical, hormonal, psychological and social changes that

occur3-4 and is likely to affect intimacy and sexual function.

5 Cassis et al.3 and Rezende6 stressed that female sexual

function remains an under-investigated and neglected topic

in medical research. These authors consider that there are

several unanswered questions regarding the changes in

sexual function during pregnancy. 3,6

Sexual dysfunction can be considered as an inability to

participate in desired sexual intercourse and may be a sign

of biological or psychological problems, or a combination

of both. Low sexual desire, low sexual arousal, lack of

orgasm, and intercourse pain are symptoms of sexual

dysfunction. These symptoms prevent women from

experiencing satisfaction from sexual activity, may affect

their quality of life, are associated with negative effects on

self-esteem, as well as in interpersonal relationships. 4

There is a lack of consensus over whether female sexual

dysfunction (FSD) increases with increasing gestation, or

whether there is a temporary improvement in the second

trimester. In a different perspective, Khalesi et al.7 in their

research, concluded that pregnant women sexual interest

decreased in the first trimester, increased in the second

trimester, and decreased at the end of the third trimester. In

relation to primiparous women, Cassis et al.3 found a huge

risk factor for the development of, or worsening of pre-

existing, sexual dysfunction. The vast majority (86.1 %) of

primiparous women in their study were suffering from FSD

during the third trimester of pregnancy. About this, authors

such as Mcdonald et al.8 also refer a strong association

between FSD and decreased physical, emotional, and overall

life satisfaction. In a different perspective, Dwarica et al.9,

stressed that sexual satisfaction can fluctuate throughout a

relationship and with significant life events and that should

as well be considered.

Several authors mention that the effect of pregnancy on

women sexual function and satisfaction is not well studied

and highlighted the changes undergone during pregnancy,

their impact in overall quality of life, and the relevance of

those experienced changes by women and their partners,

being discussed with health care professionals. 3,6,9-13

Most women are sexually active during pregnancy and many

express concerns over the impact of sexual activity on the

foetus and the pregnancy. 5,10-11,14-17 The research conducted

by Branecka-Wózniak et al.2 with patients of the pregnancy

pathology ward, demonstrated that higher levels of sexual

satisfaction in every dimension, were associated with higher

level of satisfaction with life and emphasize the need for

comprehensive perinatal care and professional sexual

counselling.

Surucu et al.18 in their study found out, that the sexual

dysfunction rates of the participants were high during

pregnancy, and their sexual quality of life decreased as the

pregnancy months progressed. With different results, the

research of Kucukdurmaz et al.19 reported that the sexual

dysfunction rate was higher in the first and third trimesters

compared to the second trimester.

Cassis et al.3 mention that the improvement in sexual

functioning that they found in the second trimester, has

been seen in several previous studies like the one conducted

by Vannier and Rosen. 20 In the first trimester, many

pregnant women suffer from physical symptoms such as

nausea and vomiting, breast sensitivity and a worsening

sense of well-being. Some of these symptoms decrease in

the second trimester and there is a psychological adjustment

to the changes as well as less fear of miscarriage. For some

women, pregnancy may result in improved awareness of

their bodies and therefore increased sensuality. Others feel

less inhibited. For others, the vaso congestion of the genitals

during pregnancy may increase sexual desire and improve

sexual response. 6 In the third trimester women experience

more physical and anatomical changes such as increased size

of the abdomen, which interferes in the sexual activity,

vaginal discharge, foetus movements and increased vaginal

humidity, amongst others. There is also the fear of preterm

labour and all these factors may contribute to the

subsequent decline in sexual activity and function in the last

trimester. Dwarica et al.9 also included as factors

contributing to the decrease in sexual activity during

pregnancy, the physical discomfort, fear of injury to the

foetus, loss of interest, physical awkwardness, painful coitus,

and perceived lack of attractiveness. In this context we

emphasize that only one study reported an increase in sexual

satisfaction in the third trimester. 21

In a different perspective, Oche et al.17 highlighted that,

myths about sex during pregnancy related to preterm labour

or miscarriage, are very strong factors in the avoidance of

sexual contact. These authors evaluated the attitude, sexual

experiences, and changes in sexual function during

pregnancy, and they found out, despite most of the

respondents mentioning desire and sexual satisfaction, 99%

refer less frequency in sexual intercourse during pregnancy.

The decline in sexual activity was associated with fear of

harm to the foetus and premature labour. However, some

of the women who maintained sexual activity, mentioned

the need to show love for partners, to ensure marital

harmony and satisfy their sexual urge. As so, those authors

consider that it is imperative that health professionals take

the initiative to approach these subjects during individual

examination time, thus encouraging woman to

communicate more freely in an open manner.

Unfortunately, sexual function during pregnancy is not

always routinely addressed by care providers. 7,10. In a survey

8 | Tereso, A..

Review Article

that included 141 pregnant women in Canada, Bartellas et

al.10 found that only one third of women received

information from their provider about sexual activity during

pregnancy and nearly half brought up the topic themselves.

Khalesi et al.7 in their work, concluded that sexual function

showed significant regressions over time during pregnancy

and that it is a widespread problem during this stage. These

authors expect, because of their study, to draw the attention

of health providers, to sexual problems of pregnant women.

They argue that it’s unacceptable that health professionals

neglect these issues, and that an effort should be made to

prevent or treat the sexual problems of pregnant women.

During pregnancy, health care professionals can play a

decisive role in prenatal care appointments and parental

preparation classes addressing the sexual function and

satisfaction. This can be determinant, not only to develop

knowledge about the effect of pregnancy in these areas, but

also, to identify problems and be able to respond

appropriately to the pregnant woman needs. Cassis et al.3

and Rezende6 concluded that the importance of sexual

function in overall quality of life is well known and so it is

of paramount importance that this topic is discussed with

women and their partners by their healthcare providers. In

this regard, sexual health should be regarded as an important

component of general health; effective and accurate

guidance is considered to contribute to the maintenance of

psychological health and the improvement of women’s

health. 18

Barriers, which can contribute to a lack of screening for

sexual dysfunction, include patient discomfort with sexual

topics, scarcity of provider training about sexual medicine,

and a perceived shortage of time to address these concerns

during health care appointments. 22

To improve the access to information about sexual function

and satisfaction during pregnancy, it’s important to identify

and map the valid, reliable, and specific assessment

instruments and their possibilities and limitations to prevent

problems, identify women needs, and plan specific health

care interventions. In this context, the synthesis of the

evidence about the effectiveness of the application of these

instruments to evaluate sexual function and satisfaction of

pregnant women will allow health professionals and

researchers to choose, in a more judicious way, the

instrument which best suits a particular group or population.

Methods

From preliminary search in PROSPERO (database of

prospectively registered systematic reviews), MEDLINE

(EBSCOhost), the Cochrane Database of Systematic

Reviews (EBSCOhost), and the Joanna Briggs Institute

(JBI) Evidence Synthesis, no scoping reviews about the

topic were identified.

Aim and research questions

The aim of this scoping review (ScR) is to map, in the

scientific literature, the assessment instruments to evaluate

the sexual function and sexual satisfaction of pregnant

women in prenatal health care context.

Consistent with JBI methodology23 this scoping review will

highlight the available evidence and identify what

instruments allow the evaluation of sexual functioning and

sexual satisfaction of the pregnant women. The ScR is

appropriate for this review, as this methodology is used to

identify and analyse factors related to a particular concept.

The defined review questions are:

1. What instruments have been used to evaluate sexual

function of pregnant women in prenatal health care

context?

2. What instruments have been used to evaluate sexual

satisfaction of pregnant women in prenatal health

care context?

3. Is there evidence of the effectiveness of the

application of these instruments to improve sexual

function and sexual satisfaction of pregnant women?

This ScR a priori protocol, is being described in accordance

with the reporting guidance to address a systematic review

protocol, provided by Preferred Reporting Items for

Systematic review and Meta-Analysis Protocols (PRISMA-

P) checklist (Additional file 1). The planned review will be

reported according to the PRISMA extension for ScR

(PRISMA-ScR) Checklist (Additional file 2). 24 This

protocol will be conducted in accordance with the JBI

guidelines23 and will include all research studies referring to

instruments that evaluate sexual function and sexual

satisfaction of pregnant women.

The structure of this ScR protocol, ensuring systematic and

repeatable work, will follow these stages: define and align

the objective and review questions; develop and align the

inclusion criteria with the objectives/questions; describe

the planned approach to searching, selection, data

extraction, and presentation of the evidence. 25

This study protocol has been registered in the Open

Science Framework (registration number: osf.io/csg8t).

Eligibility criteria

These criteria will follow the participant, concept, and

context (PCC) framework.25

Participants

This review will consider studies that include pregnant

women with more than 18 years.

Concept

This protocol will consider studies that explore instruments

to evaluate pregnant women sexual function and sexual

satisfaction, and the effectiveness of this instruments

application to improve sexual function and sexual

satisfaction of pregnant women.

Context

The context considered is prenatal care.

Study design

This ScR will cover all scientific articles on the subject

whether they result from a single or multidisciplinary view

(midwifery, nursing, psychology, medicine, or others). The

selected documents will be linguistic limited to Portuguese,

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English, Spanish and French languages. With respect to

time, documents published from 2018 onwards will be

included. This period of 5 years was considered, to follow

the JBI guidelines25, which guide researchers to consider an

interval between 5 and 10 years.

Quantitative, qualitative, or mixed studies, will be used

either published or unpublished. Analytic documents that

consider or analyse points considered important to the

research subject will also be considered.

Information sources

To identify documents potentially relevant to the ScR, two

types of information sources will be used:

1. Electronic databases via EBSCOhost: CINAHL

Complete, MEDLINE Complete, MedicLatina and

Cochrane Database of Systematic Reviews, and via

OVID: JBI EBP. Other electronic databases:

ScienceDirect, ISI WEB OF KNOWLEDGE,

Pubmed, Web of Science and Google Scholar.

2. Other documents from sources such as the Open

Access Scientific Repository of Portugal, main

organizations focused on sexuality during pregnancy,

national and international health organizations that

published reports, guidelines or orientations to health

professionals related to this research study.

Search strategy

The search strategy for this ScR follows the next points:

1. The defined search strategy will have an initial search

carried out in two significant databases (CINAHL

Complete and MEDLINE Complete) to identify

relevant articles about pregnant women sexual

function and sexual satisfaction. The search strategy

will be based on the mnemonic "PCC" according to

the JBI recommendations. 25 This review will consider

studies that include pregnant women (with more than

18 years) as participants; studies that explore

instruments to evaluate pregnant women sexual

function and sexual satisfaction, and the effectiveness

of this instruments application to improve sexual

function and sexual satisfaction of pregnant women.

The context considered is prenatal care. From this,

key words (Table 1) and indexed language (Table 2)

mentioned in the titles and abstracts of the searched

articles related to the topic are defined. The search

strategy, including all identified keywords, and index

terms, will be adapted for each included database. 25

Table 1 – Key words identified in CINAHL and MEDLINE

PCC

Key words

Population

Pregnant women

Expectant mothers

Pregnancy

Concept

Sexual function

Sexual intercourse

Sexual behaviour

Sexual activity

Sexuality

Sexual satisfaction

Concept

Questionnaires

Instruments

Evaluation

Scales

Context

Prenatal care

Antenatal care

Health care

The search expression with natural language

identified in the initial search in CINAHL and

MEDLINE databases, operated with Boolean

operators, includes truncation and wild cards:

(Pregnan* OR Expectant mothers) AND (Sexual

function OR Sexual intercourse OR Sexual

behavio?r OR Sexuality OR Sexual satisfaction)

AND (Questionnaires OR Instruments OR

Evaluation OR Scales) AND (Prenatal care OR

Antenatal care OR Health care).

10 | Tereso, A..

Review Article

Table 2 – Search strategy for CINAHL Complete and MEDLINE Complete, including search limits.

Data Bases

PCC

Descriptors

Search Limits

CINAHL

Complete

Population

MH “Pregnancy”

MH “Expectant Mothers”

Date of publication (from

2018 to 2023)

Language

(Portuguese, English,

Spanish and French)

Concept

MH “Sexual Intercourse”

MH “Sexual Behavior Analysis”

MH “Sexual Satisfaction”

Concept

MH “Questionnaires” MH “Structured

Questionnaires”

MH “Scales”

Context

MH “Prenatal Care”

MEDLINE

Complete

Population

MH “Pregnancy”

MH “Pregnant Woman”

Concept

MH “Sexual Behavior”

MH “Coitus”

MH “Sexuality”

Concept

MH “Surveys and Questionnaires”

Context

MH “Prenatal Care”

The search expression with indexed language, to be

used in CINAHL is: (MH “Pregnancy” OR MH

“Expectant Mothers”) AND (MH “Sexual

Intercourse” OR MH “Sexual Behavior Analysis” OR

MH “Sexual Satisfaction”) AND (MH

“Questionnaires” OR MH “Structured

Questionnaires” OR MH “Scales”) AND MH

“Prenatal Care”.

The search expression with indexed language, to be

used in MEDLINE is: (MH “Pregnancy” OR MH

“Pregnant Woman”) AND (MH “Sexual Behavior”

OR MH “Coitus” OR MH “Sexuality”) AND MH

“Surveys and Questionnaires” AND MH “Prenatal

Care”

2. Secondly, a search will be conducted by adapting

the terms described in the previous section for

each of the sources mentioned. For refinement,

the bibliographic references of all identified

articles and studies will be reviewed to include

additional studies.

3. Research the information by adapting the terms

described in point 1 to each of the mentioned

sources. The reading of titles and abstracts by the

two reviewers independently (using previously

established questions), will allow them to select

the ones that meet the eligibility criteria and that

will be chosen to read in full.

4. Reading and analysis of the reference list of all

selected documents, to identify additional

bibliography, considered as grey literature.

Data charting process

Data management

The Covidence (an online software tool) in partnership

with Cochrane allows the researcher to optimize the entire

systematic review process and is an element that facilitates

the independent collaboration of the reviewers. So, the

selected documents will be uploaded to the Covidence web

tool. For the references management, the Mendeley

software will be used.

Data selection process

Two reviewers will independently carry out the four stages

of data selection: identification, selection, eligibility, and

inclusion. 25 If ties occur in the evaluation of the reviewers,

a third reviewer will participate.

Data collection process

The data collected in each of the selected documents will

be organize according JBI25 as shown in table 3, which will

group the most relevant information to answer the research

questions, as well as the characteristics of the

studies/documents. This selection will be an iterative

process and the frame will be adjusted as the data extraction

proceeds.

Table 3 – Data extraction instrument.

Evidence source details and characteristics

Study ID

Title

Authors

Year of publication

Country of origin

Clinical setting

Characteristics

Aim/Purpose/Objective

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Methods (study design)

Participants/sample

Ethical considerations

Relevant results

Type(s) of instrument(s) used to evaluate sexual

function and/or sexual satisfaction of pregnant

women

Description of specific type

of each instrument and it’s

characteristics and

specificities

Instruments possibilities and

limitations

Effectiveness of each

instrument application to

improve sexual function

and/or sexual satisfaction of

pregnant women

Level of evidence

Limitations

Suggestions

Critical appraisal of individual sources of evidence

As one of the objectives of the ScR is to cover as much

information, and in this case as much information as

possible about assessment tools, and because it is not

mandatory criterion24, we abdicate of the assessment of the

quality of documents.

Synthesis of results

The research results will be presented in the PRISMA

flowchart (Additional file 3). The data extraction table

will show them in an organized and descriptive way,

considering the review questions. Thus, it is important

to identify the assessment instruments, their

characteristics, specificities, and their possibilities and

limitations to evaluate sexual function and sexual

satisfaction of pregnant women in prenatal health care

contexts. These results will be presented in a

descriptive and analytical way, with an associated table

where the characteristics of the studies and

documents are described.

Discussion

To approach the sexual function and sexual satisfaction

during pregnancy, it’s important to map the valid, reliable,

and specific instruments and their limitations and

contributions to the identification of the pregnant women

needs. As there is no universal instrument to evaluate

sexual function and sexual satisfaction during pregnancy, it

is necessary to know the effectiveness of these instruments

and their limitations. This requires analysing their

specificity, validity, reliability, and applicability in prenatal

health care contexts that also can be very diverse.

Therefore, it is crucial to map instruments that can identify

needs of the pregnant women that requires health

professionals’ intervention. Mapping these instruments will

allow to summarize the most widely used ones and identify

their possibilities and limitations. It is further added that the

choice for an instrument should consider suitable levels of

evidence and degrees of recommendation. 26

Study Limitations

Finding’s limitations that may occur can be related with the

access to information sources, namely linguistic and time

limits that may exclude some relevant sources.

List of abbreviations

JBI - Joanna Briggs Institute

PRISMA-P - Preferred Reporting Items for Systematic

review and Meta-Analysis Protocols

ScR - Scoping Review

Dissemination

The results will be disseminated through presentation

scientific events, publication in a peer-reviewed journal,

academic nurses training, and working multidisciplinary

groups about the research subject.

Authorship

Tereso and Curado have designed and elaborated this ScR

protocol. Brantes and Antunes participated in the writing of

the manuscript text and in the methodological options. The

four authors have read and agreed with the content and are

responsible for the accuracy and completeness of the final

version.

Conflicts of interest and Funding

The authors declare that they have no conflicts of interest

with respect to the authorship or publication of this article.

They declare there’s no funding and state that the opinions

expressed in this article are their own and not from an

official position of the institutions or financial agent.

Acknowledgments

Not applicable.

 
 
 
 
 
 
12 |   Tereso, A..     
            
Review Article 
 
Sources of support / Financing 
No sources of support.  
 
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